Age-related macular degeneration (AMD) affects the macula, the central portion of the retina responsible for detailed vision. It does not cause total blindness — peripheral vision is generally preserved — but it can make reading, driving and recognizing faces increasingly difficult.

AMD is one of the most common reasons patients are referred to a retina specialist, and it is the condition around which much of the research at Retina Macula Institute of Arizona is built.

Dry AMD and wet AMD are managed differently

The two forms of AMD share a name but behave differently, and the distinction determines how the condition is followed and treated.

Dry AMD is by far the more common form. It develops as deposits called drusen accumulate beneath the retina and the light-sensitive cells of the macula gradually thin. Progression is usually slow, measured in years, and early dry AMD may cause no noticeable symptoms at all.

Wet AMD occurs when abnormal blood vessels grow beneath the retina and leak fluid or blood. It is less common but progresses far more quickly, and distortion or central vision loss can develop over days to weeks rather than years. Wet AMD is the form that most often requires prompt treatment.

Dry AMD can convert to wet AMD, which is why patients with dry AMD are monitored on a schedule even when their vision feels stable. Advanced dry AMD is discussed separately on our geographic atrophy page.

Risk factors

AMD is multifactorial, and having a risk factor does not mean the condition will develop.

  • Age — risk rises substantially after 50, and again after 65
  • A family history of macular degeneration
  • Smoking, which is the most significant modifiable risk factor
  • Cardiovascular disease and high blood pressure
  • Lighter iris pigmentation

Smoking cessation and management of blood pressure and cardiovascular health are the factors most within a patient’s control, and are worth discussing with your primary care physician.

Symptoms to watch for

  • Straight lines — door frames, window blinds, lines of text — appearing wavy or bent
  • A blurred, dim or blank area in the center of vision
  • Needing more light than before to read comfortably
  • Difficulty recognizing faces at a conversational distance
  • Colors appearing less vivid

Distortion of straight lines is a symptom worth reporting promptly rather than waiting for a scheduled visit, because it can indicate a change from dry to wet AMD.

How AMD is diagnosed and monitored

Diagnosis begins with a dilated examination of the macula. Optical coherence tomography (OCT) is central to both diagnosis and ongoing monitoring — it produces a cross-sectional image of the retinal layers, showing drusen, thinning and any fluid that would indicate wet AMD.

When wet AMD is suspected, fluorescein angiography or OCT angiography may be used to identify abnormal blood vessels and map where leakage is occurring. Fundus photographs document the appearance of the macula so that change can be measured against a baseline rather than estimated.

Many patients are also asked to check an Amsler grid at home. It is a simple square grid; looking at it one eye at a time can reveal distortion between office visits, and any new waviness or missing area is a reason to call.

Treatment approaches

Treatment depends on the form of AMD and its stage.

For wet AMD, anti-VEGF medication delivered by injection into the eye is the standard of care. The eye is numbed beforehand, the injection itself takes moments, and treatment is typically given on a repeating schedule that is adjusted based on how the retina responds on OCT. The aim is to reduce leakage from abnormal vessels and limit further damage to the macula.

For dry AMD, management centers on monitoring, addressing modifiable risk factors, and nutritional supplementation for patients whose disease stage fits the criteria studied in the AREDS2 trial. Retina Macula Institute of Arizona also offers Valeda photobiomodulation therapy for appropriate patients with early- to intermediate-stage dry AMD who meet specific clinical criteria.

Because AMD is an area of active research, some patients are eligible for clinical trials studying investigational treatments. Trial participation is always optional and is discussed separately from routine care.

Which approach is appropriate depends on your examination, imaging and history. Your physician will review the options that apply to your situation.

Questions patients ask about macular degeneration

AMD affects central vision and generally spares peripheral vision, so it does not cause total blindness. Advanced disease can nonetheless make reading, driving and face recognition very difficult, which is why monitoring and timely treatment matter.

AMD frequently involves both eyes, though not necessarily at the same time or to the same degree. When one eye is affected, the other is examined and monitored closely. Patients sometimes do not notice change in the second eye because the stronger eye compensates, which is one reason for checking each eye separately at home.

The eye is numbed with anesthetic drops or gel before the injection, and most patients describe pressure rather than pain. Mild irritation, a red spot on the white of the eye, or a scratchy sensation for a day afterward are common. Your physician will explain what to expect and what warrants a call.

There is no single schedule. Patients with early dry AMD and stable vision may be seen once or twice a year, while patients receiving treatment for wet AMD are often seen every four to twelve weeks. Intervals are set by what your examination and OCT show and are adjusted over time.

No. The AREDS2 formulation was studied in patients at particular stages of AMD, and it is not indicated for everyone with the diagnosis. Whether supplementation is appropriate for you depends on the stage of your disease, and it should be discussed with your physician rather than started on assumption.

Reading, watching television and using screens do not accelerate AMD. Using more light and magnification when needed is reasonable and does not cause harm to the macula.

Concerned about your central vision?

Distortion of straight lines or a change in central vision should be evaluated rather than watched. Call (602) 613-5473 to schedule an evaluation at our Scottsdale office, or send us a message.